Checking In With James Gelfand, U.S. Chamber of Commerce

Of the myriad business groups weighing in on health legislation, none is as powerful as the U.S. Chamber of Commerce.

While the Chamber is on record as supporting health care reform, it remains staunchly opposed to two major components of the bills now on Capitol Hill: proposals for an employer mandate and a government-sponsored health insurance plan.

Recognized as the largest business federation in the world, the Chamber represents more than three million businesses  96 percent of which employ fewer than 100 people. But it also represents most of the nation’s largest businesses, including those in the insurance industry. With grassroots clout and political muscle, it is a key stakeholder in the health care debate.

The Chamber of Commerce is not mincing words. The senior manager of health policy for the Chamber, James P. Gelfand, says: “The problem is instead of focusing on the 90% of issues that everyone can agree on, we’re getting stuck on the 10% ideological, uncompromisable, unworkable provisions like creating a government-run insurance plan, forcing employers to provide health insurance. That’s the kind of stuff that reads like a poison pill.”

He spoke with KHN Reporter Jenny Gold.

Q: What kinds of reforms DO you support?

A: So you look at the 90%, you’re talking about lowering health care costs, you’re talking about improving quality. This is Medicare reform, this is payment reform, this is disease management and prevention, health IT, mom and apple pie. You’re not gonna find anyone who disagrees with that. We’re definitely on board with all that. It’s just a question of can we pare this legislation down to get rid of this stuff we’re never going to agree on. I think the answer is yes. But I’m not holding my breath.

Q: In congressional testimony, the Chamber’s senior vice president Randel Johnson said the [employer mandate] pay-or-play proposal “holds a Sword of Damocles over the necks of America’s job creators.” Do you believe it represents that kind of threat?

A: You [have to] pare this down to the simplest form — what does this employer mandate do? It makes people who don’t make a lot of money worth less to their employers. Say to yourself, I want to hire someone. I want them to do a simple task. It’s probably worth about $7 an hour. And then you realize, oh wait, because of a new law, I’m going to have to provide gold-plated health insurance. So instead of $7 an hour, it’s going to be more like $20 an hour. Let me tell you something, that person is not getting a job. So we’re just trying to make Congress understand this is a bad, bad policy. It’s gonna hurt the people they want to help.

Q: Many people say the plans on the table right now help lower income people the most. Why does the employer mandate hurt those people who are unable to get insurance?

A: Let’s look at the plan as a whole and what it’s going to do for people who don’t make a whole lot of money. If they’re lucky enough to keep their jobs, which many of them will not be — in fact, a model developed by the president’s own chair of the Council of Economic Advisers found that 4.7 million jobs would be lost based on this employer mandate — well, their benefits are going to be taxed. We’re going to tax them when they buy Coca-Cola. We’re gonna tax them when they buy alcohol. We’re going to force them, if they have a small health plan that they can afford and that appeals to them, to buy a big, rich, expensive health plan. Yeah, I think they’re getting the shaft here.

Q: Many argue that a public option would provide a cheaper alternative to small businesses who struggle to afford health care. Why is the Chamber opposed?

A: There are no business associations in favor of a government-run insurance plan. There are two groups out there that are talking about it, but they’re not real business groups. The Main Street Alliance was created last year to push this health reform bill. It’s created by unions and other leftist groups. The Small Business Majority is run out of Washington D.C., and it has no small business members.

In terms of the U.S. Chamber Our problem is cost shifting. When we look at the plans that our members buy, all of our health insurance costs 20 percent to 30 percent more because Medicare and Medicaid — government-run insurance plans — don’t pay doctors enough. So when we’re looking at this new government-run plan, especially if you look in the House legislation, it says it will use the same rates as Medicare — we’re saying wow, our costs are going to go up another 20 percent to 30 percent. No thanks.

Q: Obviously, the Chamber is opposed to both the employer mandate and the public option — is one worse than the other?

A: They’re both terrible policies. I think our number one issue is gonna be the employer mandate, mostly because for every issue that’s problematic, there’s another group that it’s their first priority. Whereas with the employer mandate, it’s pretty much going to be our responsibility.

Q: What’s your take on the Congressional process thus far?

A: This is absurd. You have legislation that’s going to affect every employer, every job creator. It’s going to affect every worker. Every single American is going to be affected by this legislation. And we’re just going to put out an 850-page bill and pass it without reading it? That’s ridiculous. I think we need to slow down, we need to think about this, especially if we’re going to be spending $1 trillion to $2 trillion. I mean, this is not something we should take lightly.

Q: So far, advertising on health care has been fairly restrained. At what point is it time to ramp up opposition? And what might it look like?

A: You don’t start a battle with nuclear weapons. First thing we’re going to do is try to work inside the system, try to work especially with Sen. Baucus to fix this thing. We don’t want to launch nukes. We don’t want to have a war. We want to support legislation. What will happen at the end of the day? Will Charlie Rangel work with us? I don’t know. I can tell you that at the hearing, he specifically, clearly said, we need the Chamber to get this done. He’s right. And I think as Congress slowly comes to the realization, oh wait, we can’t jam this down America’s throat, we can’t roll employers, we can’t roll the U.S. Chamber, I think the process is going to improve, and hopefully we won’t have to do any of these war tactics of buying air time and stuff like that. Just keep in mind, though, that we could if we had to. We have a massive grassroots network. We put out one e-mail asking people to write letters to Congress about the employer mandate and about the public plan, and we generate somewhere around 50,000 letters to Congress. So I think Congress is realizing that it’s gonna be trouble if they try to roll us.

We really do need reform, and I’m sorry that things have gotten to the point where we’re having to beat up on members of Congress who are proposing wacky schemes instead of pragmatic legislation. I think we could reform the health care system in the United States for $200 billion to $300 billion at most. All we would have to do is reform the insurance market, create a connector that works and implement some cost controls. If we do those three things, almost everybody could get coverage and it would be a fraction of the cost of what we’re looking at doing right now.